How Important is Embryo Quality?

Have you ever gone into a jewelry store and been told that every diamond is exactly the same? My guess is no. Each has its own quality score. The same is true for embryos!

I have patients that come to me from all over the world. There’s one question I always ask when reviewing their IVF cycle history. What was your embryo quality?

I hear time and time again from patients that they don’t know it because their doctor told them embryo quality doesn’t matter with IVF.

That’s simply not true!

Just like diamonds in a jewelry store. Quality matters. Just like there is a grading system for diamonds, there is also a grading system for embryos. It’s important for you to know that this exists and to ask for your embryo grade.

When it comes to getting pregnant and IVF, the implantation rate is determined by the embryo quality and rating.

How embryo quality is determined

  1. The cavity size: refers to the fluid-filled cavity of the embryo and is assigned a number
  2. The inner cell mass which gets a letter to describe the quality
  3. The trophectoderm (the cells around it) which also gets assigned a letter to describe the quality

With this scoring system, you might see an embryo graded as 5AA, 3BB, 2BA, etc. Each of these means something different! This is called the Gardner system of embryo grading.

It’s important to talk to your doctor about this because each lab may have a different grading system in place.

I’m going to give you a scenario. Let’s say you want two kids and you have two embryos. One is really good quality and the second is of lower quality.

If you didn’t have this quality information before your transfer then you might be really regretful that someone didn’t tell you to do another cycle first before transferring.

What if that second baby is something you try to achieve with that first set of embryos three or four years later when your eggs aren’t as good quality? That’s really difficult information to learn at the time of the transfer — that the embryos you had left in storage are poor quality.

It’s much better to have full transparency upfront. That’s exactly why I’m doing this show and writing this post. It’s so heartbreaking for me to see patients go through failed transfers.

To be clear, there are things out of my control and failed transfers do happen. However, it’s important to set the right expectations going in. It’s helpful to know what your chances are should things not work out as planned.

Embryo quality matters more than age

A recent Cornell study ( found that excellent quality embryos are associated with much higher rates of implantation and live birth when compared to those with lower quality.

They also showed that maternal age at the time of the egg retrieval does not affect the success of implantation or live birth.

They also found that of the three components of embryo grade that inner cell mass and trophectoderm seem to have the most influence on the pregnancy rate. Whereas cavity size does not correlate with outcomes as much.

What does all of this mean for you? The letter scores are more important than the number in your score. A 1AA grade embryo is better than a 2BB.

In Conclusion:

As a fun bonus, I want to share one more thing! If you’ve been following me for the past year or so then you know I’ve been developing my Egg Whisperer pants for increased comfort during fertility care.

Well, (drumroll), I’m so happy to announce that the pants are finally here! You can get The Egg Whisperer Pants on my website and learn all about how they work and what they’ll do to make your fertility visits and overall treatment more cozy and comfortable.

As always, please comment below or send me a note if you have any questions about this show or if you have a suggested topic for a future show.

You can also catch more of me and topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!

Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer:

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store